Veterinary Help With Cushings


marktime@...
 

I need to find a vet who is knowledgeable about the treatment of Equine Cushings.  I live in Southwest Missouri and have just received results of a Dex Suppression test that confirm Cushings in my 15-year-old Foxtrotter gelding.  The two vets I have consulted do not seem to know  much about this condition.  


Can anyone recommend a vet?


Thanks,


Judy Meadows

Barry County, MO


Mandy Woods
 

Hi Judy,
The best thing you can do right now is send your local vets to this website.  It is our educational site.   Many vets confuse the two conditions,   Cushings with Insulin Resistance  because some of the symptoms overlap!   We can help you with your horse and teach you how to help your vets!  Send them here:
 
 
We would like  you to join the ECH8 group and fill out the questionnaire so the volunteers can see the ‘’big picture’’!   Tell us every little detail you can recall – everything he eats, how much,  treatments etc.   The details are needed!   It’s the same thing as you going to a doctor and getting a questionnaire to help them diagnosis you.     Which brings me to the DDT/E ‘s .   These abbreviations mean DIAGNOSIS,   DIET,   TRIM  and EXERCISE.   This is our philosophy and it works!   You have a DX of Cushings aka PPID so the next step is getting your medication for your boy.   If you do not medicate him the tumor will grow and he will become laminitic.   Please avoid laminitis at all cost.  
 
 
You say your Foxtrotter is Cushings diagnosed by the Dex Suppression test.  Lucky boy that he didn’t founder from that.   It has the potential to push a close to the edge horse over into founder.   The safest test is the eACTH test which is a single blood pull.   Did one of your vets prescribe pergolide for him?   The compounded pergolide works well.   There is also a tablet called Prascend that is the very same thing at 10 times the cost.   Many of us use the compounded pergolide at a fraction of the cost.  You can get one mg for about $25  a month. 
 
Cushings is a benign brain tumor that is treated with Pergolide.     Insulin Resistance is a metabolic condition managed by DIET.  Foxtrotters are often IR so your boy could possibly be both.     Is he foot sore now?  What made you suspect Cushings?    What you should do to day is start the Temporary Emergency DIET.   This is safe for any horse and it is the building blocks of a custom DIET that he will benefit from.   If he is IR,   this could be very critical.   Pull him off pasture today.  Soak his grass hay for one hour pouring the water where he cant get to it.  This actually reduces the sugar in the hay up to 30%.   Then you will add these minerals ~~ vitaminE,  Loose iodized table salt,  freshly ground flax seed and magnesium.  The recipe is in the Start Here file on this site and in the IR Files at www.ecirhorse.org  You can get everything at Walmart!
 
   Judy,   it really seems like a lot to do but it gets easier,   we can show you lots of ‘short cuts’  and help you balance his minerals.   That is your goal ~ to have your hay analyzed so you know exactly what  you are feeding him~ then balance  your minerals to that assay.   It becomes second nature and you might be surprised how many members are in Missouri to help you !   This diet supports the Cushings horse as well but it is critical for an IR horse.
 
TRIM is a balanced foot with toes backed from the top and heels lowered.   Boots and pads can make him feel comfortable if needed.  Bed him deeply with sawdust or shavings.   Keep  him in a drylot and let him move at liberty **IF** he is NOT on any NSAIDS (bute etc). 
 
EXERCISE is great to improve IR but never force a laminitic horse to move. Hand walking for 5 minutes a day is a great start.
 
Please read the files and start a journal on your boy.  You have lots of help here.   Just post a question!  There are members all over the world.
 
 
Your question ‘’can anyone recommend a vet’’ may not be needed.  We’ll coach you! 
 
Here are some links you will need:
 
  
http://www.freil.com/~mlf/IR/ir.html    ~~  this is our calculator ~ just plug in your numbers and units
 
 
 
http://www.softrideboots.com/1/
 
 
 
www.equi-analytical.com ~~ this is where you’ll send your hay sample
 
 
http://www.all-natural-horse-care.com/good-hoof-photos.html 
 
 
Mandy in VA
EC Primary Response
OCT 2003
 
 
 
 


Marian Graves
 

I'm sorry, I must disagree with this information and enter this discussion.

 

"Hi Judy,

The best thing you can do right now is send your local vets to this website.  

 

Your question ‘’can anyone recommend a vet’’ may not be needed.  We’ll coach you!" 

 

There are plenty of good vets who CAN and would WANT to help you. I would visit the AAEP website and search "Get-a-DVM” for help in locating AAEP members. This will help you locate a MO Equine vet who is a member of American Association of Equine Practitioners and then contact them for inquiry on their interest or expertise in PPID. Or even call the AAEP Office for Member listings-859-233-0147. I count over a 100 in MO in my Member Directory. Most vets would welcome the discussion and many vets are now well-versed in PPID, EMS, and management of what is now called insulin dysregulation/ID. This has been a topic of many veterinary CE conferences in recent years and many vets are now developing specialized interest in this field. Keep in mind, the info on endocrinology has changed rapidly over the past years with emerging research, and this has often been difficult for vets to exclusively focus on in practice.

 

Additional resources can be found on the Equine Endocrinology Group website (sites.tufts.edu/equineendogroup). These specific EEG members located at Universities can also assist you in locating someone well-versed in endocrinology.

 

Even though I am *NOT* an employee of BI any longer, the phrase "the compounded pergolide works well" is not factual in many cases. Sometimes it works, sometimes it doesn't--and it is NOT the same as FDA-approved drug. There is no guarantee of potency, stability, or efficacy with compounded medication, and if you have a dosing error or other adverse safety issue--you're on your own. Not the same. Compounded pergolide has helped many a horse in the past, but it should not ever be compared on the same plane as an approved drug, which undergoes consistent potency and quality testing batch to batch. Ask your compounder for such data on stability and potency, and you will likely 1) not receive an answer 2) receive data they generated internally (not evaluated by an outside source). Dr. Jennifer Davis just in 2012 compared 21 additional formulations of compounded pergolide (as follow up to her 2009 study on aqueous pergolide on file) and once again, found huge inconsistency. One formulation from Wedgewood actually had NO measurable pergolide for the 180 days of study evaluation. Only 4 met the +/- 10% of stated 1mg label concentration from the compounder on Day 0 of the analysis. Yes, it's generally cheaper, but it should be. Compounded pergolide is a crapshoot. Depends on the quality of the compounder, the active pharmaceutical ingredient/API (legally, compounders have to now formulate products from approved Prascend, but we all know many don’t and use illicit API), the batch to batch mixing, etc. It is not the same as Prascend, which must be manufactured under strict quality control batch to batch with ongoing stability testing through the product’s market lifecycle. 

            To the persons recently who posted about giving 32-36 of compounded pergolide—given that the average recommended dose range of pergolide is 1-5 mg/day…do you think perhaps trying an FDA approved drug might be a good strategy? Giving 36 mg a day goes against ANY recommendation from world-renowned experts in PPID. And, if you don’t see a response until you reach that level, could it be that there is little to no drug in your compounded product? Perhaps trying a drug with known potency might be a logical answer, and may even be cheaper than what you are paying at that level of dosing.

 

I do agree with the comment on Dex Suppression. This IS an outdated test, although it has done a decent job of diagnosing advanced PPID. It is no longer being recommended due to inferior sensitivity and the perception it will cause laminitis. Please refer to the EEG link above on Tier 1 and Tier 2 tests now recommended.

 

Lastly, I would have your vet contact Boehringer Ingelheim Veterinary Technical Services for questions. (No, I don't work for BI anymore). They can assist with resources, PPID case management, and lastly, if needed, helping to perhaps locate additional veterinarians in MO. They are there to assist vets and the clients they serve. For real. Your vet has their number. 

 

Veterinary/DVM involvement is an integral component of progressive horse care. Sometimes equine vets cannot be readily found in rural areas or vets with certain expertise, and seeking online advice is understandable. But resources DO exist to help you. Denying your horse the input of a licensed medical professional is not a good strategy moving forward--nor would it be so in human health care. This site should serve as a helpful forum and resource to support total horse health, not "replace" professional veterinary care or promote veterinary medical advice disseminated from laypersons.

 

Marian Little, DVM

Paris KY

2009

 





Mandy Woods
 

Marion,
I take great umbrage with your comments to me.   You have taken almost my entire post to Judy and twisted it to suite your personal vendetta against this list.   I am here to HELP people  help their horses.   You have single handedly disrupted the work I have done for reasons that do NOT belong here.   I hope to hell we don’t lose Judy and her horse because of your little  attitude and consequent remarks but if we do its YOUR FAULT.   You did NOT read what I wrote.  You took my words out of context.   I recommended she send her vets to our educational site.   No where did I say SHE DOESN’T NEED A VET !   We CAN help her and we will help her IF she stays long enough.  Your thoughtless words to show off your alleged knowledge  of Prascend vs Compounded Pergolide may  cost this horse his soundness OR WORSE.   Now arent you so proud of yourself for “”first do no harm”” that you swore to lead by?  
 
SHAME on YOU Marion.  
 
Mandy
 
 
 
 
 

Sent: Tuesday, October 28, 2014 3:01 PM
Subject: RE: [EquineCushings] Veterinary Help With Cushings
 


I'm sorry, I must disagree with this information and enter this discussion.

 

"Hi Judy,

The best thing you can do right now is send your local vets to this website. 

 

Your question ‘’can anyone recommend a vet’’ may not be needed.  We’ll coach you!"

 

There are plenty of good vets who CAN and would WANT to help you. I would visit the AAEP website and search "Get-a-DVM” for help in locating AAEP members. This will help you locate a MO Equine vet who is a member of American Association of Equine Practitioners and then contact them for inquiry on their interest or expertise in PPID. Or even call the AAEP Office for Member listings-859-233-0147. I count over a 100 in MO in my Member Directory. Most vets would welcome the discussion and many vets are now well-versed in PPID, EMS, and management of what is now called insulin dysregulation/ID. This has been a topic of many veterinary CE conferences in recent years and many vets are now developing specialized interest in this field. Keep in mind, the info on endocrinology has changed rapidly over the past years with emerging research, and this has often been difficult for vets to exclusively focus on in practice.

 

Additional resources can be found on the Equine Endocrinology Group website (sites.tufts.edu/equineendogroup). These specific EEG members located at Universities can also assist you in locating someone well-versed in endocrinology.

 

Even though I am *NOT* an employee of BI any longer, the phrase "the compounded pergolide works well" is not factual in many cases. Sometimes it works, sometimes it doesn't--and it is NOT the same as FDA-approved drug. There is no guarantee of potency, stability, or efficacy with compounded medication, and if you have a dosing error or other adverse safety issue--you're on your own. Not the same. Compounded pergolide has helped many a horse in the past, but it should not ever be compared on the same plane as an approved drug, which undergoes consistent potency and quality testing batch to batch. Ask your compounder for such data on stability and potency, and you will likely 1) not receive an answer 2) receive data they generated internally (not evaluated by an outside source). Dr. Jennifer Davis just in 2012 compared 21 additional formulations of compounded pergolide (as follow up to her 2009 study on aqueous pergolide on file) and once again, found huge inconsistency. One formulation from Wedgewood actually had NO measurable pergolide for the 180 days of study evaluation. Only 4 met the +/- 10% of stated 1mg label concentration from the compounder on Day 0 of the analysis. Yes, it's generally cheaper, but it should be. Compounded pergolide is a crapshoot. Depends on the quality of the compounder, the active pharmaceutical ingredient/API (legally, compounders have to now formulate products from approved Prascend, but we all know many don’t and use illicit API), the batch to batch mixing, etc. It is not the same as Prascend, which must be manufactured under strict quality control batch to batch with ongoing stability testing through the product’s market lifecycle.

            To the persons recently who posted about giving 32-36 of compounded pergolide—given that the average recommended dose range of pergolide is 1-5 mg/day…do you think perhaps trying an FDA approved drug might be a good strategy? Giving 36 mg a day goes against ANY recommendation from world-renowned experts in PPID. And, if you don’t see a response until you reach that level, could it be that there is little to no drug in your compounded product? Perhaps trying a drug with known potency might be a logical answer, and may even be cheaper than what you are paying at that level of dosing.

 

I do agree with the comment on Dex Suppression. This IS an outdated test, although it has done a decent job of diagnosing advanced PPID. It is no longer being recommended due to inferior sensitivity and the perception it will cause laminitis. Please refer to the EEG link above on Tier 1 and Tier 2 tests now recommended.

 

Lastly, I would have your vet contact Boehringer Ingelheim Veterinary Technical Services for questions. (No, I don't work for BI anymore). They can assist with resources, PPID case management, and lastly, if needed, helping to perhaps locate additional veterinarians in MO. They are there to assist vets and the clients they serve. For real. Your vet has their number.

 

Veterinary/DVM involvement is an integral component of progressive horse care. Sometimes equine vets cannot be readily found in rural areas or vets with certain expertise, and seeking online advice is understandable. But resources DO exist to help you. Denying your horse the input of a licensed medical professional is not a good strategy moving forward--nor would it be so in human health care. This site should serve as a helpful forum and resource to support total horse health, not "replace" professional veterinary care or promote veterinary medical advice disseminated from laypersons.

 

Marian Little, DVM

Paris KY

2009

 





PapBallou@...
 

Marion -

Your post is old news.  We've seen it before, and I doubt few will disagree that Prascend in 1mg form will most likely have better potency than 1mg of compounded, even when not in powder or liquid form.

But, there is a huge amount of suspicion about BI based on several events on the list.  Because of that, there will be many who bristle at anything you or anyone else associated with BI may say.

You're not preaching to a new group of parishioners but those who have been there, done that, and many of us can probably talk our own vets under the table about PPID.  If that weren't the case, BI wouldn't have had to mount such a huge campaign WRT their product.  It would have been fully embraced as 'at last!  It's here!'

A veterinarian posted similarly awhile back about how she has nothing to do with BI but supported the data that was published for the efficacy of Prascend.  A quick check of BI's website, and gosh, there she was.  One of the vets involved with the BI data acquisition. 

A senior veterinarian within BI was actually contacting list members privately, encouraging the use of Prascend.

BI is so far missing a great opportunity to really grab some great PR, and support.  What is BI's position on assisting horse owners where they simply can't afford the amount of Prascend that's needed, especially when they have more than one that needs it?  (I would think 2mg is a deal breaker for many - it would be an issue in my fairly financially comfortable household).

The big push is tantamount to simply offering the bullet.

Linda and Pap Ballou, and dearest Doba, and Nice Guy - all PPID
EC Primary Response
West Coast
May 2004



Elva J Mico
 

Hi Judy,
I have been a member of this list since 2004 and it has helped me immensely. It is sometimes difficult to find a vet who is knowledgeable about Cushings but they are around. And if you can find one that will listen to your concerns and listen to the information you get from this list that will be wonderful. Even if your regular vet doesn't know much about Cushings - if he is willing to listen to you and the experience from this Cushings list, that would be terrific. And that would make him a great vet.

I'm sure you will have a choice between Prascend from a drug company and getting a compounded pergolide. I do want to tell you that the compounded pergolide is cheaper and for my two horses, Beau and Whiskey, works very well. The Prascend is very expensive and I personally do not believe it is necessary, however that is a personal opinion. (Altho there are probably thousands on here who also use the compounded form) I've had their Cushings under control for the past couple of years using compounded pergolide. And I use the capsules which I get from Thriving Pets.

The one thing I am against is the dex suppression test, and the moderators here will tell you it is not the best for your horse - it really is not reliable. If you can find a vet who will do the ACTH test and send it to Cornell for testing you will get accurate results.

To the list - Judy and I have known each other for many years via horse lists - Judy - there is so much experience on this list I am sure you will benefit. You know my email if I can answer any questions for you.

Hugs to all your horses,
Elva and Angel Satin
NM/2004

On 10/28/2014 9:13 AM, marktime@... [EquineCushings] wrote:
I need to find a vet who is knowledgeable about the treatment of
Equine Cushings. I live in Southwest Missouri and have just received
results of a Dex Suppression test that confirm Cushings in my
15-year-old Foxtrotter gelding. The two vets I have consulted do not
seem to know much about this condition.


Can anyone recommend a vet?


Thanks,


Judy Meadows Barry County, MO


Nancy C
 

Oh Marian.  You’ve stepped in it this time, IMO. You have very clearly demonstrated that you have rarely if ever actually followed anything that goes on here.  Who said anything about “denying professional veterinary care”?

ECIR has been telling folks from the very beginning to get their vets involved. Horse owners are desperate to get their vets involved in a positive manner for the long term health of the horse.  ECIR established ecirhorse.org for just that end because so many vets did not and still do not understand PPID and IR. 

“Endocrinology changing rapidly” may have happened in your world, but the members here have been ahead of the curve from the beginning.

ECIR recognized Dex as potentially dangerous and potentially giving false positives long ago. Fourteen years to be exact.   Way before the EEG or anyone else decided we horse owners weren’t crazy.  It was not a “perception”. Check the archives.

Just last week I had an AAEP vet (not my vet) recommend to me to give baking soda to my IR horse so I could put him back on grass.  This is also recommended by another AAEP vet who also sells supplements on the theory that acidosis from “sugar” in the hind gut causes hyperinsulinemia. Baking soda will solve this little problem.  Is that an AAEP or BI/EEG rec now?

Your post has brought a few additional follow up questions to mind...

Why does the EEG recommend that higher amounts of Prascend can be given if the owner can afford it, but if not, um.... (See recs in your links)

Why do some AAEP vets refuse to prescribe any more than 3 mg of Prascend even when the owner can afford it and it is obviously needed as clearly demonstrated by blood work and symptoms?

Why is it okay to have 30% of the horses in BI’s study not responding positively to the recommended level of Prascend?

It would be okay with you though, if the  ECIR Group works to educate owners and vets of the value of the drug in a correctly diagnosed horse,  right?  There are many who won’t prescribe pergolide at all, because they are laboring under myths and bad science about the drug.

Why do most AAEP vets not understand the benefit of titrating on to pergolide to avoid “side affects” or know there are ways to help the horse comfortably transition on?

Why do “specific EEG members located at Universities” believe horse owners are “suspect at best” when it comes to understanding and reporting what their horses are going through?

How many specific PPID/IR cases have these specific EEG members located at Universities followed long term and for how long? 

Why do so many AAEP vets think PPID is  “just old age?” and IR, or your “ID”, is just because the horse is fat?  This group has known both to be false for years.

Thank the deities there are AAEP Vets (mine for example) who are willing to work with this group.  They recognize the value of what the group has been able to do, and what the collective expertise can bring to the discussion and care of these horses. 

After years of struggling with vets who didn't care, didn't know, didn't want to know, or had bad info, I finally found a vet willing to work with me for the benefit of my horse who I am still able to work and ride.  I am so very thankful.  So many others are not so lucky.

I sure hope Teri sees your post because it appears you haven’t followed those background discussions either.

Nancy C in NH
ECIR Moderator 2003
Learn the facts about IR, PPID, equine nutrition, exercise and the foot.
www.ECIRhorse.org
Check out the FACTS on Facebook
https://www.facebook.com/ECIRGroup
Support the ECIR Group Inc., the nonprofit arm of the ECIR Group
Equine Cushing's and Insulin Resistance Group Inc.

 





---In EquineCushings@..., <mariangraves@...> wrote :

I'm sorry, I must disagree with this information and enter this discussion.

 

"Hi Judy,

The best thing you can do right now is send your local vets to this website.  

 

Your question ‘’can anyone recommend a vet’’ may not be needed.  We’ll coach you!" 

 





marktime@...
 

I do not have a place to dry lot Rudy.  He has never shown any foot tenderness or laminiticsymptoms.  I have tried to watch his weight, putting him in the corral overnight when grass is rank and when he is getting free choice hay in the winter.  For the past several years he has grown a four inch long winter coat that does not shed readily.  He has had a voracious appetite and gained weight.  All my saddles quit fitting till I got a Skito pad to fill in his topline.  Lately, he has lacked his usual energy.

I never dreamed that the premier equine vet in the area would give the dex suppression test!  But I left him there for it, knowing that he was not founderprone.  He got 4.4 on both blood draws.

The vet is sending me his test results plus a 60 day supply of powdered pergolide for $116.00!  I am to give a mg a day.

Judy
SW MO


Nancy C
 

Sorry Marion but I have one more comment...

If you or Dr Gockowski would be willing to share Dr Davis's 2012 pergolide study, Id be happy to put it in the files.

Nancy C in NH
ECIR Moderator 2003
Learn the facts about IR, PPID, equine nutrition, exercise and the foot.
www.ECIRhorse.org
Check out the FACTS on Facebook
https://www.facebook.com/ECIRGroup
Support the ECIR Group Inc., the nonprofit arm of the ECIR Group
http://ecirhorse.org/index.php/equine-cushing-s-and-insulin-resistance-group-inc

 

 





marktime@...
 

Elva, you are the reason I joined this list.  :)  I knew Dex Suppression was not good from research I did.  But never dreamed the famous vet in our area would test that way!!!  I thought he was an expert!  I doubt he has time to learn about treating Cushings since he only has three Cushings horses in his large practice.  My regular vet knew even less, just treated one horse for it 15 years ago!!!

I appreciate everyone's comments and advice.  I can pick and choose what seems most helpful in Rudy and my situation.  He is only 15 and I would like to continue riding him.

Judy
in SWMO


PapBallou@...
 

Judy -

Please, don't pick and choose!  Go back to Mandy's post that was written to you from an owner's perspective, and her many, many years volunteering on this list - this is not just chat info but cutting edge information on how to manage a horse with cushings.  It is what has kept my boy, 21, with 10 years of cushings on a sound and happy road.

Your comments about the two vets in your area are exactly what Dr Little needs to understand exists in OUR universe.  Not her non-clincal universe. 

I thank you for making that point for us.

Please.  Reread what Mandy has to say.

Linda
EC Primary Response
West Coast
May 2004



marktime@...
 

Linda, I am still trying to digest the information that has been presented and to see how it applies to my horse and how I might implement it. I am overwhelmed to get so much interest and support. :)

Thanks,

Judy
In SWMO


Teri
 



Nancy...and Marian,

>>>I sure hope Teri sees your post because it appears you haven’t followed those background discussions either. 

I sure did!   (I am the one who's pony is taking 32 mgs compounded pergolide caps (16 am - 16 pm) a day.)

Just for the record ...my vet started Stormy on 1/2 mg Prascend in Dec. 2011.  (And no, we did not titrate up because he didn't know that we should) Thanks to finding this group and having a very open minded, willing to learn vet...he switched Stormy to 4 mgs compounded pergolide in Nov. 2012.   
And to repeat myself...my vet freely admits that if it weren't for the info from this group, Stormy would have been 6 ft. under a long time ago!  Unfortunately, like too many vets, he was not that well educated on Cushings or IR.  (He was also full of BI bologna!) 
My story is like so many others. I was getting bad advice from him and two other vets. Like...Safe Choice IS 'safe'!  Try Purina Sr....'not enough molasses to hurt her'.  When it didn't help her gain wt., I was told to try Enrich 32.  Sigh.... Then I pumped her full of NSAIDs to try to help the laminitis pain!  (As directed by the vets) Stormy was going downhill fast!  She spent the winter, and most of the spring, flat out on the ground.  She literally did not get back on her feet till I found this group!   I am not trying to bash vets...my vet is great....just lacked knowledge on PPID/IR. Like you Nancy,  I am extremely thankful he was open to the advice/collective knowledge of this group.

My head is spinning.
You go Nancy ...and Linda!!!!  

Teri and Stormy
Indy 4-2012





gentpony
 

Hi Marian,

 

I would be most interested in reading the detailed protocol and all the findings of Dr Jennifer Davis you mentioned in your post:

 

“Dr. Jennifer Davis just in 2012 compared 21 additional formulations of compounded pergolide (as follow up to her 2009 study on aqueous pergolide on file) and once again, found huge inconsistency. One formulation from Wedgewood actually had NO measurable pergolide for the 180 days of study evaluation. Only 4 met the +/- 10% of stated 1mg label concentration from the compounder on Day 0 of the analysis.”

 

Since a prime purpose of this forum is for sharing data and facts about PPID, would you please provide this information to the group?  When and where was it published?

 

 

I’ve searched ivis, google, google scholar, PubMed, etc and can find no mention of this study, although the abstract for her original 2009 study is easily found on PubMed:

 

http://www.ncbi.nlm.nih.gov/pubmed/19210262

 

J Am Vet Med Assoc. 2009 Feb 1;234(3):385-9. doi: 10.2460/javma.234.3.385.

Effects of compounding and storage conditions on stability of pergolide mesylate.

Davis JL1, Kirk LM, Davidson GS, Papich MG.

 

For anyone interested, a more expanded version of this 2009 study can be found here, scroll down to the second last study at the end of the document:

 

http://www.cvm.ncsu.edu/vhc/efac/equine/documents/EMSAnnualReportandResearchOverView2009PDF.pdf

The Effects of Compounding and Storage Conditions on the Stability of Pergolide Mesylate.

-Jennifer L Davis. PAGES 30-31 IMMUNOLOGY SECTION.

 

 

Eva

SW Ontario,  March 2005


Maggie
 

Hi Judy,

So many of us have been where you are--overwhelmed and confused.  Know this--the DDT/E philosophy works!  All four aspects must be in place for the best results.  I have a couple of thoughts.

One, Diagnosis.  Since your vet did the DST to diagnose PPID, you don't really know for sure if IR is an issue for Rudy as well, but it looks highly suspicious for a couple of reasons.  A high ACTH can drive the insulin up causing IR as well.  Consequently, all PPID horses should be treated as though they are also IR until proven otherwise.  Like Mandy said, "avoid laminitis at all cost"!!  It will not hurt Rudy, even if he is not IR at baseline, to at least temporarily start the emergency diet, until you can get your vet on board with the recommended lab work, (ACTH, insulin, glucose and leptin on a NON-fasting horse).  Leptin resistance goes hand in hand with insulin resistance.  Leptin is the hormone that says "stop eating".  Your comment that Rudy has a voracious appetite and has gained weight, makes him very suspect to be insulin and leptin resistant, especially given that his PPID symptoms have been going on for "the past several years."

Here is the link to Cornell's website.  It's the lab that we recommend you send your blood work.  The bundled ACTH, insulin and leptin is $62 + $8 to add a glucose.  Ask your vet if he/she will do these particular tests for you.  They are explained in detail on our website, which Mandy gave you the link to.  He may (will) charge you more than what the actual cost is, but those 4 tests are what you need to know if you are dealing with only PPID or also IR at baseline as well.

https://ahdc.vet.cornell.edu/test/list.aspx?Species=7&Test_Name=acth&TstTyp=&WebDisc=

 I also see that your vet is giving you a 60 day supply of powdered pergolide.  Please know a couple of things.  The compounded powdered pergolide IN CAPSULES is what we recommend, but the powdered pergolide in a jar will help you with your initial weaning on to the drug.  Make sure you stir the powder up each time you dose as the medicine and the carrier can settle and separate, and stirring will help you get more accurate dosing.  The reason that we recommend the capsules is that each time you open the jar of powder the drug is exposed to humidity and light and that has a degrading effect on the medicine.  The capsules help preserve the integrity of the drug within.  Still, we recommend that you order only 30 days at a time and keep it in the door of the frig.  Here is one place that you can fill a prescription that your vet writes you for pergolide:  http://www.pethealthpharmacy.com/

You want to wean Rudy on to pergolide slowly to avoid the initial side effects that some but not all horses experience when starting onto the drug.  We call it the "pergolide veil" and the symptoms are depression and lack of appetite.  I know, it probably seems that Rudy could not possibly have a lack of appetite!  But it can be a sobering side effect if it does happen.  So you will want to start him with 0.25 mg/day for 3 or 4 days and increase the dose by 0.25mg every 3 or 4 days until he is at the target dose.  After at the target dose for 2 weeks we recommend retesting the ACTH to see if it is being controlled with the target dose.  There are also some other subtle symptoms that may help you and your vet decide if you are at the target dose.   Please read this scale of symptoms post from Patti:  https://groups.yahoo.com/neo/groups/EquineCushings/conversations/messages/111988  Another thing that can really help with the pergolide veil is a product called APF, available at some local tack and feed stores, online, and through their website:  http://www.auburnlabs.com/html/eqProdGen.html

Please take the time to join ECH8 and fill out the case history form on Rudy.  Mandy has sent you a link, and an invitation as well.  It really does give us the details we need to help you better.

Maggie, Chancey and Spiral in VA
March 2011
EC Primary Response
http://pets.groups.yahoo.com/group/ECHistory4/files/maggie%20in%20virginia/


millionairess1989
 

Hi Judy,

I just wanted to add a few words of support. My Arabian mare's PPID condition was confirmed by the dex suppression test as recommended by a board certified equine internal medicine specialist! Fortunately she didn't have any side effects. I later learned from the group about ACTH testing and have done this ever since.

Read and learn as much as you can about these diseases. You'll have to be your own horse's advocate. No vet, no matter how well meaning or devoted, has unlimited time or effort to devote to becoming the font of knowledge for every diseases known to mankind. This group sees more horses in a month that many vets might in a year or longer. Some just don't have the experience or the up to date knowledge provided by the group.

At the eight vet practice at which I work everyone could recognize a traditional PPID presentation. One of the three large animal vets sees most of the PPID/IR horses and prescribes Prascend. I doubt that any of them know about the Pergolide veil, titrating the dose and/or adding APF. Thankfully one of them  recognizes the research I do and signs my compounded Pergolide prescriptions. He knows that my horse is tested several times a year and asks me about the proper testing procedure for his patients.

There are all different kinds of vets out there. Some think they know everything and won't listen to you. Others admit they don't know as much but are willing to learn. Use the information from this group to empower yourself in dealing with a vet to find one you can work with for Rudy.

Good luck to you both.

Jennifer and Mill in TN
Jan 2011
http://pets.groups.yahoo.com/group/ECHistory8/files/Millionairess


Tina Martin
 

"To
the persons recently who posted about giving 32-36 of compounded
pergolide—given that the average recommended dose range of pergolide is 1-5
mg/day…do you think perhaps trying an FDA approved drug might be a good
strategy? Giving 36 mg a day goes against ANY recommendation from
world-renowned experts in PPID. And, if you don’t see a response until you
reach that level, could it be that there is little to no drug in your compounded
product? Perhaps trying a drug with known potency might be a logical answer,
and may even be cheaper than what you are paying at that level of dosing."


Dear Dr. Little and Dr. Gockowski,

I'm the one giving 36 mg of compounded pergolide to my horse, Rio, and he is doing well and being ridden. Although your post is so far from reality that it is almost not worth my time to reply, here is a great idea:

Please feel free to contact me for my banking information so you can send me the $1,836 every month that it would cost me to "try the FDA approved drug".  If Prascend works better at that dosage level I can decrease the amount given.  I do monthly blood tests anyway to monitor Rio's ACTH levels.

I am German and am embarrassed for Boehringer Ingelheim, a German firm, for charging an exuberant amount for a blister packing a product that had been used for the same purpose for many years.

Shame on you, too, for disrupting the so very necessary flow of information to horse owners on this site!

Tina & Rio
Atlanta, May 2011 


 

To those who claim this groups advocates NOT using a vet, nothing could be further from the truth.  I get chastised by members regularly for not wanting to involve my local vets in cases involving my client horses.  

Unfortunately, we do not have a vet in our very rural area who prescribes to the current protocols involved with these diseases, but I have learned from this group to consult with them anyway.  It is my hope that if I have enough success with this group maybe they will get on board.   I have realized the necessity in consulting with a vet, regardless of their views if for no other reason that to protect both my and the owners legal position in the way we deliver care to the horse.  

I have clients who have actually driven their horse(s) hundreds of miles away to find a vet they can work with.  I would not have encouraged that if not for the strong encouragement of this group and Dr. Kellon. 

Debora 
02/2012 


marktime@...
 

Thanks for the valuable information, Maggie.  I do try to watch his weight.  He has been fatter.  He has no cresty neck, has never had sole tenderness in the 13 years we have had him. He gets Remission, which I know is controversial as to effectiveness.  He gets a cup of mixed grain, mostly oats morning and evening, to put the supplement in and to give him something to do while the other horses eat.  We might not see the horses regularly without some grain as we have 85 mostly wooded Ozark acres.  The pasture is poor.  We have never fertilized as we never wanted lush pasture.  Pasture here is generally fescue which gets very thick and rich when fertilized and leads to what they used to call "chronic founder," and is now recognized as IR. We have never had a horse with that. 

We have short Bermuda grass since we have fed Bermuda hay some years, and clover, other odd grasses and tree leaves.  I know stressed pasture can be higher in sugar.  In 30 years of horsekeeping we have never had IR or Cushings.  We just lost an Arab/quarter gelding after 29 years at the age of 31 this spring, still have a 27-year-old Arab mare we have had since she was a yearling, plus her  23-year-old son, a 14-year-old MFT gelding and Rudy, MFT. 15.  We have had the MFT's for ten years and thirteen years respectively.

Our current hay is orchard grass, but we are not feeding hay right now.  It would be nice to have it tested.

The Pergolide they showed me at the vet's was in a box.  It was certainly expensive at $116.00 for 60 mg.

Judy


marktime@...
 

Mandy,

I tried to join the ECR8 group, but it will not accept my registration.

Judy